CC FINAL

hydroxyurea treats

sickle cell disease

IV methylene treats

methemoglobinemia

hemoglobin lab

12-17

disseminated intravascular coagulation DIC

Body's clotting system becomes overactivated everywhere in the bloodstream

S DIC

bleeding*, ecchymosis, petechiae, purpura, oozing or frank bleeding, cool extremities, dyspnea, chest pain, hematuria

tx DIC

anticoagulant, antifibrinolytic, FFP, fibrinogen, platelets, bleeding precautions

dx DIC

 increased D-dimer lab, decreased platelets, increased PT and PTT

S hyperglycemia

polyuria, polydipsia, polyphagia, fatigue, blurred vision

hyperthyroidism

Thyroid produces too much thyroid hormone T3 and T4, increases metabolism

common cause of hyperthyroidism

graves disease- autoimmune hyperthyroidism

S hyperthyroidism

tachycardia, palpitations, hypertension, heat intolerance, diarrhea, exophthalmos- bulging eyes, goiter- enlarged thyroid, anxiety

tx hyperthyroidism

antithyroids, beta blockers, radioactive iodine, thyroidectomy

complication of hyperthyroidism

thyroid storm- untreated hyperthyroidism

S thyroid storm

fever, tachycardia, hypertension, agitation, HF, arrhythmias

hypothyroidism

Thyroid does not produce enough thyroid hormone T3 and T4, slows down

S hypothyroidism

weight gain, cold intolerance, fatigue, bradycardia, slow thinking, memory issues, constipation, dry skin/hair

tx hypothyroidism

levothyroxine- synthetic thyroid hormone, taken on empty stomach

complication hypothyroidism

myxedema coma- untreated hypothyroidism

S myxedema coma

 hypothermia, decreased LOC, bradycardia, hypotension, hyponatremia

potassium lab

3.5 - 5

calcium lab

8.6 - 10.2

phosphorus lab

3 - 4.5

magnesium lab

1.5 - 2.4

Tx 2nd degree AV block mobitz II

Transcutaneous pacing to permanent pacemaker

sinus bradycardia tx

atropine, transcutaneous pacing

ventricular fibrillation tx

CPR, defibrillation, epinephrine

pulseless ventricular tachycardia tx

CPR, defibrillation, epinephrine

pulse ventricular tachycardia tx

amiodarone, cardioversion

supraventricular tachycardia SVT unstable tx

cardioversion

defibrillation

shock delivery for life threatening rhythm

cardioversion

used for rhythms with a pulse

MAP <65 =

tissue ischemia

MAP formula

systolic BP + 2 x diastolic, divided by 3

low ANC =

neutropenia

ANC formula

WBCs x (neutrophils% + bands%) divided by 100

neutrophils

mature

bands

not mature yet

ANC >1500

normal

ANC 1000 - 1499

mild neutropenia

ANC 500 - 999

moderate neutropenia

ANC < 500

severe neutropenia, high risk for infection

ANC < 100

profound neutropenia, extreme sepsis risk

cardiac tamponade tx

fluids, pericardiocentesis

initial stage of shock

Decreased O2 to tissues

Slight changes in vitals but within normal range, MAP changes

compensatory stage of shock

Tachycardia, abnormal respirations, confused, agitated, cool moist skin (endless distributive), respiratory alkalosis

progressive stage of shock

hypotension, MAP <65, rapid shallow respirations, crackles, absent bowel sounds, low urine output, mottled skin, petechiae, cold extremities, weak/absent pulses, metabolic acidosis due to kidneys kicking in

Distributive shock- warm extremities turn cold in this phase

refractory stage of shock

Anaerobic metabolism: cells make energy without oxygen, tissue hypoxia, necrosis, ischemia, severe hypotension, erratic HR, coma, metabolic acidosis, hepatic failure- jaundice, high bilirubin, renal failure, anuria

hypovolemic shock

volume loss blood or fluid

S hypovolemic shock

systolic pressure <90, tachycardia, tachypnea, cool skin, decreased output, mental status changes

Tx hypovolemic shock

rapid fluid resuscitation, blood pressure support, vasopressors, albumin

cardiogenic shock

heart cant pump enough blood

S cardiogenic shock

fluid overload, low cardiac output/afterload issues, pulmonary congestion- crackles, decreased organ perfusion, decreased blood flow to brain- changes in LOC, decreased urine output

Tx cardiogenic shock

vasodilators

distributive shock

vasodilation causing vascular blood pooling

early S distributive shock

warm periphery due to peripheral blood pooling

types of distributive shock

neurogenic, anaphylactic, septic

neurogenic shock

spinal cord, nervous system

S neurogenic shock

bradycardia, warm skin, hypotension, altered LOC, organ dysfunction, decreased O2

tx neurogenic shock

maintain blood pressure- maintain MAP at 70, IV fluids, vasopressors, atropine for bradycardia 

tx anaphylactic shock

epinephrine, antihistamines

septic shock

toxin

S septic shock

early- tachycardia, flushed skin, bounding pulses, late- hypotension, cool mottled skin, weak pulses

obstructive shock

obstruction of blood or oxygen flow

causes of obstructive shock

PE, cardiac tamponade, pneumothorax, pulmonary hypertension

qSOFA tool

1 point for each:

Lungs RR > or equal 22 

Change in mental status 

Systolic BP < or equal 100

nasal cannula flow

1-6L

FiO2 24-44%

nasal cannula uses

mild hypoxia, COPD, long term therapy

face mask flow

5-10L

FiO2 35-60%

face mask uses

moderate hypoxia, post-op, trauma

venturi mask flow

4-12L

FiO2 24-50%

venturi mask uses

COPD, precise O2

non rebreather mask flow

10-15L

FiO2 60-95%

non rebreather mask uses

severe hypoxia, respiratory distress

partial rebreather mask flow

6-10L

FiO2 50-70%

partial rebreather mask uses

hypoxia with higher FiO2 needed

causes of respiratory acidosis

hypoventilation- respiratory depression, airway obstruction, asthma, sedatives, COPD, pulmonary fibrosis, penumothorax, flail chest, stroke, MI

causes of respiratory alkalosis

hyperventilation- brain injury, overventilation- mechanical vent

causes of metabolic acidosis

GI loss of base bicarb- diarrhea, DKA, renal failure, addisons disease

causes of metabolic alkalosis

GI loss of acid- vomiting, NG suction, diuretics, penicillin, cystic fibrosis, cushings syndrome

S hypoglycemia

shakiness, diaphoresis, confusion, headache, tachycardia, anxiety, seizures, coma

causes of hypovolemic shock

trauma, DI, diuretics, surgery blood loss, diarrhea, vomiting, burns, DKA, elevated hemoglobin and hematocrit- concentrated blood

causes of cardiogenic shock

acute MI, HF, cardiomyopathy, valve stenosis or rupture

causes of neurogenic shock

 trauma, spinal cord injury- loses tone

S anaphylactic shock

hypotension, tachycardia, airway compromise

tx septic shock

 fluids, antibiotics

causes of septic shock

infection, sepsis, immunosuppressants, cancer, lung disease, diabetes, unvaccinated

refractory stage of shock

Shock is irreversible, usually cannot recover from this stage- total body failure

stroke modifiable risk factors

hypertension, afib, smoking, DM, hyperlipidemia, obesity, physical inactivity, alcohol

stroke nonmodifiable risk factors

old age, previous stroke/TIA, male

priority stroke assessment

time of symptom onset

dx stroke

noncontrast CT scan

ischemic stroke

thrombus forms directly inside brain artery

embolic stroke

thrombus breaks off and travels to brain vessels

hemorrhagic stroke

blood vessel breaks and bleeds in the brain

tx thrombolytic stroke

tissue plasminogen activator TPA within 3-4hr of symtptom onset, after CT

TPA/alteplase

clot busting medication

TPA is never used for

hemorrhagic stroke- TPA stops blood clotting worsening brain bleed   

tx hemorrhagic stroke

 antihypertensives, hold blood thinners- give vitamin K

rapid acting insulins

lispro, aspart, glulisine

rapid acting insulin info

onset: 10-30min, peak: 1-3hr, duration: 3-5hr